TWO black healthcare providers I had a chat with following the Section 59 Investigation Panel submission report on medical aid schemes this week, admitted racism is still prevalent at some schemes.
Albeit they wanted to be identified, as a publication we felt to protect their respective identities.
One is a general practitioner and other a Dentist.
According to them, this practice has been on-going for years’, targeted especially at newly practising health practitioners.
“We’ve presented our complaints to various health associations but to no avail. Being a black, young health provider in this country comes with a heavy price,” they asserted, also asking “how many of them have closed their practices as a result of such treatment from certain schemes and their racist attitude?”
The report, presented to the national health minister Dr Aaron Motsoaledi, this week, paints a grim picture.
Led by advocate Thembeka Ngcukaitobi and his panel, submitted that this began in 2019,when a number of healthcare providers and members of Solutionist Thinkers, which is an organisation in the space, and the National Healthcare Professionals Association, which is also another association in the space.
They made allegations that there was unfair treatment by medical aid schemes, which was based on race and ethnicity.
‘Discriminatory that black doctors flagged at higher rates for FWA (fraud, waste, abuse) than white doctors’, said Ngcukaitobi.
The more than 280-page final Report, flagged allegations of racial discrimination by medical aid schemes against black healthcare providers and concluded that the right of procedural fairness of some individual practitioners was violated.
The panel, considered it sufficient to make “only a factual finding” and decided not to make legal findings about unfair discrimination in terms of Section 9 of The Constitution or the Promotion of Equality and Prevention of Unfair Discrimination Act.
The Report solely laid blame on well-known schemes- Discovery, Gems and Medscheme, who are implicated.
“Today (Monday) they were now releasing the final findings that indeed they found it to be true that there’s racial profiling and racial action taken against black doctors, Africans Indians and Coloureds.
They concentrated mostly on three medical schemes that is Discovery, Gems and Medscheme. The three of them constituted 80% of all the members of medical schemes in the country and if you are able to make findings on 80% statistically it means the other 20% will fall in place,” said Min Motsoaledi, upon receiving the Report on Monday.
GEMS, Discover and Medscheme, applied risk ratios showing they regarded black anaesthetists, psychiatrists and dental therapists as 650%, 350% and 300% ‘more likely’ to be guilty of fraud, waste and abuse.
The Report further shows that the fraud, waste and abuse (FWA) systems of the Government Employees Medical Scheme (GEMS), Discovery Health and Medscheme racially discriminated against black healthcare providers.
The panel took the decision because it is “not a court of law” nor was it “adjudicating individual complaints, with the benefit of a trial”.
There are a number of reasons for this approach, according to the report.
Firstly, many years have passed since the panel was mandated to conduct this investigation and much has changed during this time.
Schemes and administrators appear to have remedied some of the shortcomings in their FWA systems, either in response to the panel’s findings in its interim report or publicity around the matter.
The investigation found independent expert Dr Zaid Kimmie went to great lengths to develop a valuable tool for measuring discriminatory outcomes in the FWA systems.
The risk ratios produced by his methodology faced some criticism, but the report says the findings confirm that the tool is robust, even though no conclusion has been reached that these ratios amount to unfair discrimination under The Constitution.
“The relevance of this tool remains significant,” it adds, saying it hopes its existence will encourage ongoing monitoring of risk ratios by schemes and the Council for Medical Schemes (CMS).
The report says it is important that the gains of the investigative process are not lost, particularly when so much time has passed since its inception.
The risk of making legal findings of unfair discrimination is that it may lead to prolonged future legal proceedings, it notes.
“In our view, it is more appropriate for specific individual cases of unfair discrimination to be addressed on a case-by-case basis, with specific facts of each case, and the defence of the affected scheme to be properly analysed,” says the panel.
Its recommendation is that the CMS and stakeholders must ensure that the implementation of the FWA systems does not breach The Constitution or “the provisions of the Equality Act”.
The three schemes applied risk ratios indicating that black healthcare providers were “generally approximately” more likely to be guilty of FWA than their non-black counterparts to varying degrees.
The final report confirmed that:
- GEMS – black dental therapists in 2014 experienced risk ratios of 2.7 to 3.27, labelling them some 300% “more likely”;
- Discovery – black psychiatrists in 2017 experienced risk ratios of 3.44 to 3.77, labelling them approximately 350% “more likely”;
- Medscheme – black anaesthetists in 2018 experienced risk ratios of 6.39 to 6.78, labelling them around 650% “more likely”.
The investigation was launched by the CMS after a number of healthcare providers and members of Solutionist Thinkers and the National Health Care Professionals Association in early 2019 alleged they were being treated unfairly by medical aid schemes based on race and ethnicity.
The interim report of the investigation panel found that between 2012 and 2019 black practitioners were more likely to be found to have committed FWA than their non-black (white) counterparts by GEMS, Discovery and Medscheme.
Asked on their reaction now that the report has been presented to the minister of health, both health providers alluded its ‘very late but, better than late’.
Dr Motsoaledi says he will act in due course on recommendations contained in a report.
Image (Adv Thembeka Ngcukaitobi, who led the Section 59 Investigation Panel on medical schemes racism against black health providers).
